'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Two new GPs needed for every retiree, warns report

Two newly qualified GPs are needed for every experienced doctor that retires because of young recruits opting for ‘portfolio careers’, a report on staff shortages has warned.

With newly qualified GPs preferring to work on a ‘less than full time basis’ signing up for five to six sessions a week, more are needed to sustain services when older GPs who were doing eight or nine sessions retire or leave, the report on workforce issues in North Ayrshire said.

In addition, GPs are retiring far faster than new doctors coming in, training places remain unfilled and doctors are moving out of the area, all contributing to an ‘increasingly fragile’ general practice.

The report also points out that with demand for services at an all time high at the same time as a shrinking share of NHS funding, traditional GP jobs are becoming less attractive to newly qualified doctors.

It paints a bleak picture for the 20 practices in North Ayrshire – with one currently run by the health board, another likely to be handing back its contract in August and three others suffering significant recruitment problems.

It points out as the remaining GPs experience job stress related to recruitment and retention issues within their current practice, ‘the threshold for quitting and moving is lower than in previous times’.

The report also says the need to use locums to cover shortages is further jeopardising the ‘financial viability’ of practices being run by the health board with sessional costs increasing to ‘unaffordable levels’.

Strategies in place to secure general practice outlined by the report include a tool to assess the extent to which a practice may be in difficulty and close working with practices who are struggling, including exploring options for non-medical input.

One scheme is looking at developing multi-disciplinary team across children and families, mental health; and community care to help take the pressure off GPs.

Dr Chris Black, joint secretary of Ayrshire and Arran LMC, said the changes in the way GPs work is ‘reflective of the intensity of the job’ with doctors no longer willing or able to do eight or nine sessions.

He added that the problems seen in Ayrshire were not particularly unique with the vacancy rate similar to that seen across Scotland.

‘The impact of increased workload on general practice has been difficult even if you’re well staffed. If you have recruitment difficulties on top of that, it has a knock on effect and the status quo can’t continue.’

He said that the new contract due later this year would hopefully address some of the issues around workload.

‘The LMC continue to work hand in hand with the primary care team at the health board to find solutions for practices who are having difficulties but each case is different.

‘The problem is you can’t replace the GP with someone else,’ he added.

In my part time sessions I am like most other GPs, I feel I do the work of 2 People. No breaks, non stop relentless workload. You'll need more than 2 GPs for EVERY SESSION of a GP who retires to stop this exodus and desemation of primary care general practice. It's not rocket science. Ask grass roots GPs rather than acedemics, managers, the Secretary of State etc etc

Last year we lost one of the partners in our three partner practice. He was exactly what's described- experienced and working 10 sessions a week. We now have 3 part-time GPs and an ANP, some of whom are also very experienced, to replace him and they are not covering neither his clinical nor administrative workload and that is at considerably higher cost to the practice. The net result was that we, remaining two partners, had free up time to cover (and try to stay sane), which essentially means cutting our own clinical sessions. So when Copernicus says it would take three to replace him, I agree completely. I've seen it.

we have advertised full time GP's only. would rather have fewer sessions available for patients and encourage them to register at another practice rather than take someone part time.

loss of continuity creates too many problems for the practice and it is actually better to lose patients and income than to be honest have someone part time. part time work creates too many problems.

the people that are existing can obviously remain on part time and i am really thankful to them for what they do for the practice, but going forward no more part time GP's or nurses. our work is too important and continuity is too important.

luckily we were able to recruit without too much stress. but not sure what will happen the next time.

Beware burnout. Portfolio careers are a great way to avoid the inevitable burnout - general practice is simply not a viable full time option. Buddy up for continuity, and communicate well within the practice, and it works just fine.

What we wouldn't take on is salaried GPs - part time partners are definitely the way forward. The BMA model contract, if stuck to, is in no way a reflection of a GPs job, and the difference creates too much stress in the practice, with the partners feeling like the salaried docs get an easy life and are paid more by the hour for the work they do (which, sadly for us, is true).

I replaced a 9 session gp 7 years ago, after 3 years of coping( in my mind at least) the impact on my life was too much - dropped sessions but workload remained the same at 7 sessions. All the other 5 partners did the same.

I quit for pharma 2 years ago, I do the same hours in office, next to none outside and earn approx twice as much.

Most doctors in hospital and definitely primary care massively underplay their worth.

My old practice now runs on 3 partners 2 salaried and a range of assistants but waiting time for routine appts are now 4 weeks to allow it to be affordable!

I am no legal expert and at times see the usage of the Himan Rights Act 1998 a bit over zealous....though vital and life saving

Reflecting on years of commentary and effect.. seeing rates of burnout, psychological distress, mental illness, suicidality, self harming behaviours, addictions and desctruction of family life it has got me thinking. This article and it's commentary, like so many, and the cause and effect phenomenon, mirror this.

When you read article 8 of the Act it touches on the fact that no one has the right to denude personal autonomy or interfere with private and/or family life....

One can read the pain, anger and distress in so many GPs writings and can only imagine the direct effect that this is having on their lives and the indirect effect it is having on the lives of those around them.

I am no expert and may have misrepresented the Act but it does make you think that someone somewhere, those who are the instigators of the demise of general practice, should think... their actions are simply not acceptable

ANPs and pharmacists have a role in general practice but are not a replacement for GPs. Unfortunately due to the pressures of the unrelenting workload gps are having to vote with their feet and develop their own portfolio careers. As a result Allied professionals are taking positions within practices to try and plug a gaping void. Although independent practitioners the fallback position is always to ask the GP. Everyone else can say we haven't got capacity but GPs have no such luxury. And who is going to cover the Duty Rota with fewer GPs wanting regular positions.
If primary care was properly funded the right people would be in the right roles supporting each other which is how it should be.
It's ridiculous to think that GPs can be replaced. It's only holding up because there are still GPs out there propping up the system.
I agree with proud cardigan re needing partners for equity of workload within the practice but there's not many people out there wanting the position .........can't think why🤔